Provider First Line Business Practice Location Address:
8109 GERMANTOWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19118-3458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-753-1153
Provider Business Practice Location Address Fax Number:
215-753-1153
Provider Enumeration Date:
01/03/2025